Horner's syndrome - third eyelid

happyplums

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Hi there, I'm new to this site and am turning to the forum for support and feedback.

My 10 year old calico has been diagnosed with chronic renal failure. We recently visited the vet to get a follow up check on her BUN and creatinine levels. I dropped her off in the morning and picked her up in the afternoon...all seemed pretty standard until I let her out of the carrier when we got home. She was really wobbly moving out of her carrier (not walking straight) and I noticed her right eye looked odd, with the whites appearing more that usual or turned up. Concerned, I called the vet and was told to take her back.

Upon further examination by the vet, I was told that K had what is called a third eye prolapse or Horner's syndrome, which may have been attributed to K having her ears cleaned. 

Has anyone had experience with third eyelid prolapse occurrences and if so, is time the best treatment? K doesn't seem her usual peppy self and hasn't had much of an appetite. When she gets up to move, she's rather discombobulated, particularly her hindquarters. I'm already concerned over monitoring the CRF and am besides myself with worry now with this unexpected turn. I just want for K to be comfortable.

Thanks in advance.
 

quiet

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HI;

I have seen horners syndrome before. It can be caused by trauma, ear cleaning. Usually they will prescribe an ointment to keep the eye with the prolapsed third eyelid up, from becoming to dry.

I have to ask: Why did they do ear cleaning on her with CRF? Was she sedated to do it? Were the ears that bad? The cats that I have seen with it were never off balance and didn't behave any differently.
 

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My cat ate a bird last week and got sick and the next day he had that 3rd eyelid thing happening.  It only lasted for half a day from when I first noticed it. Then I read that trauma to the throat can also cause that along with other things like ear cleanings.  My cat was also wobbly like you described.  Hopefully it is only temporary.  How is she doing today?
 
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happyplums

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HI;

I have seen horners syndrome before. It can be caused by trauma, ear cleaning. Usually they will prescribe an ointment to keep the eye with the prolapsed third eyelid up, from becoming to dry.

I have to ask: Why did they do ear cleaning on her with CRF? Was she sedated to do it? Were the ears that bad? The cats that I have seen with it were never off balance and didn't behave any differently.
Thanks Quiet.

I'm not sure the why the repeated mention of ear cleaning, especially since my main concern was to get the CRF stabilized. I was just told that her ears were really bad and I did try to clean with ear cleanser solution on a cotton ball that resulted in a lot of smelly gunk. I thought I would harm K and wasn't sure if I cleaned her ears out enough so left it to the professionals. In hindsight, I'm feeling rather guilty for having that done when the ear cleaning isn't a priority.

The vet gave her eye drops but we didn't leave with anything other than recommendation of keeping her under observation. 
 
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happyplums

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My cat ate a bird last week and got sick and the next day he had that 3rd eyelid thing happening.  It only lasted for half a day from when I first noticed it. Then I read that trauma to the throat can also cause that along with other things like ear cleanings.  My cat was also wobbly like you described.  Hopefully it is only temporary.  How is she doing today?
Thanks Moosedog

K seems to be doing better. The whites of the third eyelid doesn't appear as much but she's still rather lethargic and not keen to be moving. She displays signs of appetite but eats gingerly (renal diet, canned morsels in gravy). I'm not sure if it's painful for her to chew as she seems to prefer the generic can of Friskies (pate) that we feed our other cat over the morsels in gravy.

I'm concerned over the lack of appetite because of the CRF. She's had maybe 2-4 tablespoons of canned food since returning Thursday evening. The upside is that she's drinking a lot of water. I'm keeping hydration in mind as she had IV Fluid Therapy back at the end of June. There was a great video about subcutaneous fluid therapy that I spotted on the Cat Site which I'm going to ask the vet about too.

She does keep shaking her head every once in awhile, and doing so makes her lose her balance so she tips over. I've let her go back to her usual routine of sunning herself on the patio in the mornings, so savoring the small things. 
 

quiet

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Hi;

There is no reason for you to feel guilty about he ear cleaning. You pay your vet to take care of your cat and trust that he/she will. You don't have a veterinary degree, so obviously you are going to follow the advice of the person that does. The person you are paying for veterinary services. Do not feel guilt.

I can relate to your situation though as a recent first time horse owner I had to take the word of veterinarians and farriers as I knew nothing of horses. What I did learn was that you cannot trust anyone and the only way to really be able to help your cat/horse, is to become as knowledgeable as you can in everything to do with them. Starting with of course in your case CRF. It is all you can really do to make sure all is being done for your cat that should. I had to learn everything hoof and foot related in horses this last year and I have to say it was overwhelming. But I learned enough to achieve what I needed to in order to assure that the vets/ farriers were doing all they should.

I worked small animal specialty for the last nine years, and before that over 20 years in regular small animal vet medicine.  I have seen renal disease cats.

I can try to tell you some things that might help, but you need to get on some reputable veterinary sites and learn all you can. Be carefull because there is allot of false information out there. I like to stick with sites that are either out of veterinary teaching hospitals like cornell, or sites from AAHA, or major veterinary organizations. There is a website called Feline CRF, it has been a while since I have been on it but it used to have good information. The Merick veterinary manual online is also helpful as is DVM 360.

There has to be a 70% loss of kidney function before the renal values on blood work will be elevated. So basically only half of a kidney needs to function before the renal values will get high enough to show any abnormality in the blood. Good news is that they can live quite a while with only half of a kidney working, provided they get the proper care, and are not having additional organ failure going on.

Cats that have renal disease should have their thyroid checked as both of these diseased can go together. Blood pressure should also be checked if it can be done without to much stress as this will often be elevated.

Renal failure can be brought on by different toxins such as lilly plants, anti-freeze, etc. or by a lack of blood flow to the kidneys that can happen when a cat is under anesthesia and the blood pressure is not monitored. If the blood pressure gets low and it is not immediately corrected the kidneys don't get the proper -blood and parts of them die. The result of renal failure sometimes won't show up for 6 months to a year after the incident. Anti-inflammatory drugs such as metacam  can also cause renal damage, although there are veterinarians that still prescribe it. The drug has a black box warning on it for cats yet still they prescribe it and use it. This is just some of the things that can lead to renal disease. In the more advanced stages of renal disease there can be a significant anemia as well. That is one of the reasons to keep stress to a minimum because the body just doesn't have the reserves to deal with it.

They can and do get an acid reflux sort of thing going on and there are drugs that can help greatly with that. Pepcid is one of those drugs.

The lack of appetite comes from them feeling nausea and  also from the acid reflux. Often you will see cats sit at the food bowl and want to eat but then start salivating and smacking their lips. This is a sign of nausea. It can also be that the last time they ate that food they vomited and they associate the food with vomiting. Not many cats like the renal diets.

It is way more important for a cat to eat something, than it is for the cat to eat the renal diet. So, if the cat isn't eating the renal diet well or at all. it is better to feed him anything he wants (within reason of course) and get him eating than it is he eat the right food. The friskies you mentioned is fine as is chicken baby food provided it only has chicken, water, corn starch, and maybe citric acid in it. You must keep them eating though because they will go down quickly if they don't.

I cannot stress enough how important sub q fluids being done at home is. It is vital to start them as soon as possible as this is such a life savor in cats. If your vet will allow you to do that it is way less expensive to get the fluids in a prescription (you want one bag from them to start off with) so you can order the fluids online for only about $5 a liter as opposed to $45 or more at the vet. You can also save money by purchasing your needles (get 20 gage 3/4 inch needles as opposed to the 18 gage 1 inch needles the vet will recommend). And you can get drip lines on line as well. Get 15 drop per ml. Most cats do not mind the fluids and if you do it right it shouldn't take more than 10 minutes of your time.

Checking the specific gravity of the urine is an easy test that can be done at the veterinarians office with only a drop of urine. It basically checks how concentrated the urine is which can give an idea of how well the kidneys are working.

For blood work it is much better to have it done at a lab than in the vets office.

Keep an eye on the teethe as the gums can become very inflamed with the azotemia that can go along with the renal disease.

There are two products on the market that I have seen help. One is Epakatin which is a phosphate binder and good for cats that don't want to eat the renal diets, and the other is Azodyl a capsule that is a kidney support product. They are both veterinary products, but with an RX can be ordered on line.

An ultrasound is a very beneficial tool for getting a look at how the kidneys are and also the surrounding organs. If an ultrasound is done it is best to have it done by a specialist, a DVM DACVIM as ultrasounds are very subjective and for the money it makes more sense to have a vet that has special training do then than a vet than does not. Usually the charge is about the same.

Most important is preventing stress by keeping things the same around the house if possible. No new additions of pets or people if it can be helped.

Keeping them eating no matter what they want to eat

Keeping them hydrated by offering multiple water stations near their usual resting areas, and with sub q fluids.

With the ears, cats are so sensitive to almost anything that is put in their ears and if there is a ruptured ear drum which you can't know about if there is allot of wax, they can actually wind up getting whatever the cleaning solution is into their inner ear and that can cause problems. The best thing to do for the ears is just a culture and sensitivity to the lab and then treat with the appropriate antibiotics for whatever grows on the culture. Ear cleaning is rarely needed with cats. To be honest almost all cats that I have seen get "ear flushes" wind up with some sort of neurologic reaction. I thought it was the stress alone doing it but have seen it also with cats that have full anesthesia.

Since you didn't ask for all of this info I will leave this as it is now because I have been typing way to long. Let me know if I can help in any way. I hope your cat is doing better by the time you read this.

Another good website is DVM360
 
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happyplums

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Quite - 

THANK YOU THANK YOU THANK YOU. 

There is SO MUCH information for me to take in, but the primary focus now is getting K eating. She's lost interest even in the Friskies pate
 I've tried to mix the renal diet with the pate in the blender with some water to make a thick "smoothie" so she has less to chew but she just looks at the bowl and then walks away. I've since gotten some syringes so will assist with her eating if need be. Luckily, I also picked up some Gerber's 2 baby food (just the meat ones) and she seems to approve that for the time being along with some mushy egg whites. 

Fingers crossed that K is associating the canned food (renal and regular) with an unpleasant trip to the doctor's and she'll get her appetite back! The vet said that I'm to take her back if she doesn't eat at all today, which of course I'm reluctant to do as it may add more stress. Trying to stay positive for the super trooper !
 

quiet

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Hi;

If she was my cat and she wanted to eat the baby food only, then that is what I would give her. It isn't good long term but for a week or so it should be fine until she gets feeling good enough to eat. Is she on Pepcid or anything for acid reflux? I would assume that if she isn't eating better by now she went back to the vet. Hope she did start eating.
 

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My cat Yoshi has been exhibiting the same symptoms. My wife was cleaning his ear and he went all wild and couldn't walk right for a day and his third eyelid is showing. He will still eat wet cat food luckily, but won't touch his dry food.

How long should this last? It's been a week now and his third eyelid is still showing. Getting worried.
 

mrsgreenjeens

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My cat Yoshi has been exhibiting the same symptoms. My wife was cleaning his ear and he went all wild and couldn't walk right for a day and his third eyelid is showing. He will still eat wet cat food luckily, but won't touch his dry food.

How long should this last? It's been a week now and his third eyelid is still showing. Getting worried.
Did you take Yoshi to the Vet to have him examined to make sure nothing else is wrong, and to get eyedrops to keep his eye from drying out like the original poster did? 

Depending on exactly what the issue is would determine how long it will last, I would think.  What was wrong in the first place that his ears were being cleaned?  Does he have an ear infection or was it just routine cleaning?  Was he already losing interest in his dry food before, or is it related?  These are things the Vet should be told.
 

macman851

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I haven't had the money to take him to the vet. His ears had some dark gunk in them and we had been cleaning his ears for weeks prior with no issues. He had a very healthy appetite for his dry food before the incident. His eyes have never appeared dry, but after reading the previous posts in here I put some glycerin drops in his eyes that we had prescribed for another cat.
 

mrsgreenjeens

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I haven't had the money to take him to the vet. His ears had some dark gunk in them and we had been cleaning his ears for weeks prior with no issues. He had a very healthy appetite for his dry food before the incident. His eyes have never appeared dry, but after reading the previous posts in here I put some glycerin drops in his eyes that we had prescribed for another cat.
Well, it could be that he's feeling quite dizzy, so maybe it's just hard for him to eat his dry food without "complications".  I think you're lucky he wants to eat, because if he IS dizzy, I would think he wouldn't really feel like eating at all
.  It' s quite possible this is being caused by an inner ear infection, and he may need antibiotics to resolve it.   I only say this since it started from gunk in his ear.  Sometimes it starts from injury to the head, or issues with their chest, etc.  As sated earlier, recovery time really depends on what caused it. 

Maybe this article will be helpful:

http://www.vcahospitals.com/main/pe...e/animal-health/horners-syndrome-in-cats/3977

Also, if you cannot afford a Vet right now, maybe THIS will be helpful:

http://www.thecatsite.com/a/no-money-for-vet-care-how-to-find-help-and-save-your-cats-life
 
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